Experience and awareness of research integrity among Japanese physicians: a nationwide cross-sectional study.

OBJECTIVES: To explore the awareness and practice of clinical research integrity among Japanese physicians. DESIGN: A nationwide cross-sectional study conducted in March 2020. SETTING: All hospitals in Japan. PARTICIPANTS: Physicians aged <65 years who work at hospitals participated in clinical research over the past 5 years. The sample was stratified according to geographical location and subspecialty, and 1100 physicians were proportionally selected. PRIMARY AND SECONDARY OUTCOME MEASURES: Knowledge and awareness of research integrity. RESULTS: Among the 1100 participants, 587 (53%) had the experience of being the first author, 299 (27%) had been co-authors only and 214 (19%) had no authorship. A total of 1021 (93%) had experienced learning research integrity, and 555 (54%) became aware of research integrity. The experience of learning about research integrity was highest among those with first authorship (95%) and lowest among those without authorship (89%) (p=0.003). The majority of participants learnt about research integrity for passive reasons such as it being 'required by the institution' (57%) or it being 'required to obtain approval of institutional review board (IRB)' (30%). Potentially inappropriate research behaviours were observed in participants, with 11% indulging in copying and pasting for writing the paper, 11% for gifted authorship and 5.8% for the omission of IRB approval. Factors significantly associated with copying and pasting were being below 40 years old (OR: 1.84; 95% CI: 1.05 to 3.26), being the first presenter (OR: 1.64; 95% CI: 1.05 to 2.57) or having passive reasons for learning research integrity (OR: 2.96; 95% CI: 1.57 to 5.59). Furthermore, gifted authorship was significantly associated with being a co-author only (OR: 1.84; 95% CI: 1.18 to 2.87) and having passive reasons for learning about research integrity (OR: 1.79; 95% CI: 1.03 to 3.12). CONCLUSIONS: Most physicians conducting clinical research have learnt about research integrity, but potentially inappropriate research behaviours are associated with passive reasons for learning.

Association between nursing care delivery models and patients' health outcomes in a university hospital: A retrospective cohort study based on the Diagnostic Procedure Combination database.

AIM: This study aims to examine the association between nursing delivery models (fixed-team nursing model and Partnership Nursing System® [PNS®]) and patients' health outcomes (30-day in-hospital mortality and functional decline, indicated by a decline in Barthel Index or in-hospital mortality). METHODS: This study used a retrospective cohort design based on the data from the Diagnostic Procedure Combination database, which included routinely collected health data for Japanese administrative claims. Participants were inpatients aged 20-99 years admitted between July 2010 and August 2012 (fixed-team nursing period) and July 2014 and August 2017 (PNS® period) to an academic teaching hospital in Japan. Odds ratios and 95% confidence intervals were estimated using multivariable logistic models. RESULTS: We included 24,108 and 23,872 patients for the analyses of 30-day in-hospital mortality and functional decline, respectively (median age: 62 years; 52% women). The 30-day mortalities in both fixed-team nursing and PNS® groups were 0.5%. There was no significant association between the nursing delivery models and 30-day in-hospital mortality (adjusted odds ratio = 1.15, 95% confidence interval = 0.78-1.70). However, the PNS® group was found to have a higher proportion of patients with functional decline (2.7%) than the fixed-team nursing group (2.2%; p = .030). The adjusted odds ratio of declined function in the PNS® group, compared to the fixed-team nursing group, was 1.40 (95% confidence interval = 1.17-1.68, p < .001). CONCLUSIONS: Further studies are needed to examine how the PNS® model influences patient outcomes, especially nurse-sensitive patient outcomes.

Development of an evidence-based fall risk assessment tool and evaluation of interrater reliability and nurses' perceptions of the tool's clarity and usability.

AIM: To develop and test interrater reliability of an evidence-based fall risk assessment tool for nurses and to investigate how nurses perceived the clarity and usability of the tool. METHODS: In phase 1, an evidence-based fall risk assessment tool was developed based on a literature review and expert discussion. The finalized tool assessed 11 risk factors and comprised 23 items. In phase 2, reliability testing was done. Two nurses out of a possible 125 participating nurses independently assessed each participating patient on admission with the assessment tool. The nurses then provided feedback on the clarity and usability of the tool. The interrater reliability was estimated by the percentage agreement, Cohen's kappa, and prevalence- and bias-adjusted kappa. RESULTS: Of the 164 patients who were recruited, 114 patients participated. After adjustment for prevalence and bias, only "frequent urination" and "night-time toileting" showed a less-than-substantial interrater agreement. Assessment of the items "cognitive impairment" and "night-time toileting" were most frequently reported to be problematic. CONCLUSION: The evidence-based fall risk assessment tool requires further modification and re-examination of interrater reliability is warranted. In particular, the cognitive impairment items need to be reconsidered in order to enable nurses to better assess patient cognition on the admission day.

The predictive validity of a modified Japanese Nursing Association fall risk assessment tool: A retrospective cohort study.

BACKGROUND: Patient falls are the most common nursing care-related adverse event in hospitals. Extensive literature has been published on the predictive validity of fall risk assessment tools; however, there have been no studies examining the changes in predictive validity at different observation periods among hospital inpatients. OBJECTIVES: To examine the predictive validity of a modified Japanese Nursing Association fall risk assessment tool and to compare its predictive validity at observation periods of 7, 14, 21, and 28 days. DESIGN: Retrospective cohort design. SETTINGS: Twelve wards of a 600-bed university hospital in Japan. PARTICIPANTS: Patients 15 years and older admitted over a six-month period were enrolled. Patients were excluded if they were admitted to the intensive care unit or neuropsychiatry ward, had no fall risk assessment results within two days of admission, or had inconsistent assessment results. METHODS: Falls were observed for 28 days following admission. Predictive validity was evaluated using the area under the receiver operating curve, sensitivity, specificity, and positive and negative likelihood ratios at 7-, 14-, 21-, and 28-day observation points. Faller prevalence in each observation sample was adjusted for consistency using a bootstrap sampling method. All predictive validity indices were then recalculated and compared. RESULTS: A total of 4144 patients were admitted and 67 patients fell (1.6% faller prevalence) within 28 days of admission. The modified Japanese Nursing Association fall risk assessment tool showed a sensitivity of 0.82, specificity of 0.71, positive likelihood ratio of 2.83, and negative likelihood ratio of 0.26 at a cut-point of ≥6, and the area under the receiver operating curve was 0.83. Predictive validity in the 7-day observation sample was significantly higher than the 14- and 28-day samples, but no significant difference was found relative to the 21-day observation sample. CONCLUSIONS: The modified Japanese Nursing Association fall risk assessment tool demonstrated good predictive validity in a Japanese university hospital, but further evaluation is needed for other validity values and reliability. The findings from this study may indicate that predictive validity indices vary by the length of observation period and faller prevalence, but these findings need to be examined further.